WORKERS COMPENSATION GUIDELINES Reporting and Processing Workers Compensation Claims

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1 WORKERS COMPENSATION GUIDELINES Reporting and Processing Workers Compensation Claims In the following pages you will find frequently asked questions and answers regarding the reporting and processing of Workers Compensation claims. We have also included a copy of the current Notice Of Injury Report form and a copy of the Illness/Injury In The Line Of Duty (IILOD) form. These forms are available on the Risk Management webpage of the PCSB website. Please share this with others who may be responsible for reporting injuries in your absence. We hope you will find this information helpful. If you have any questions please contact Jennifer Hooper, Benefit & QC Specialist, Workers' Compensation, Risk Management Department at , ext WEBSITE: Jennifer Hooper, Benefits & QC Specialist, Workers Compensation 02/15/13

2 Who is eligible for coverage under Workers Compensation? Any full-time or part-time employee, substitute, or approved volunteer. How should an injury be reported? Please review the attached Notice Of Injury report form. This form should be completed any time an employee is injured at work. A work site supervisor or a designated representative from the school should call to report a claim. The injured worker should NOT report his/her own injury. If possible, the injured worker should be available to speak with the Workers Compensation nurse at the time the injury is reported. If the injured worker is not at work, ask the injured worker for a contact number so the Workers Compensation nurse can call the employee. When should a Notice Of Injury be reported? Who should report the injury/illness to OptaComp? Whenever a school official or supervisor has been notified by an employee that an injury or illness has occurred while performing work during the normal course of his/her employment. A work site supervisor or a designated representative from the school should call to report a claim. The injured worker should NOT report his/her own injury. If possible, the injured worker should be available to speak with the Workers Compensation nurse at the time the injury is reported. If the injured worker is not at work, ask the injured worker for a contact number so the Workers Compensation nurse can call the employee. Is the injured employee required to seek treatment? No, but the injury must be reported to the Workers Compensation administrator. However; when seeking treatment, in order to avoid a delay in recovery, the injured worker should be encouraged to treat the day of the injury. If the injured worker needs treatment after the initial report, the Telephonic Medical Case Manager (your assigned Workers Compensation nurse) should be contacted to arrange medical treatment. Can an injured employee seek treatment from his/her personal physician? No. In order to receive Workers Compensation benefits and benefits provided by the School Board (i.e. Injury/Illness In The Line Of Duty) treatment must be with an authorized Workers Compensation physician. How are Workers Compensation prescriptions obtained? Information is given to the injured worker by the treating facility explaining the process for filling medications prescribed by the treating Workers Compensation physician. A letter is given to the employee to present to the pharmacy when the prescription is filled. Personal health insurance cards and personal prescription cards should not be used.

3 Is post-accident drug testing required? Yes, Polk County School Board is a Drug Free Workplace. How should an emergency be handled? Is Conjunctivitis (Pink Eye) covered? In the case of an emergency, the injured worker should be taken to the nearest hospital, or if necessary an ambulance should be called. The name of the hospital should be given when the injury is reported. In some cases it may be covered (Workers Compensation will determine). If it is determined to be work-related treatment must be provided by an approved Workers Compensation physician. Are colds, strep and common flu viruses covered? No. Is Head Lice covered? Yes, if exposure is confirmed within the school. Condition should be verified by the school clinic and reported to Workers Compensation as a Report Only. The employee is not required to see a Workers Compensation physician. One day of IILOD will be given. Are Chicken Pox, Scabies, Impetigo, etc. covered? These may be covered (Workers Compensation will determine). See above. How is time charged to the injured worker on the day of the accident? If no medical treatment is rendered the employee should work regular hours. If the injured worker decides to take time off but did not seek medical treatment, time missed should be charged to the employee (sick, vacation, etc.). If medical attention is needed, the day of the injury will be a regular paid day. However, if the doctor gives a return to work and there is a reasonable amount of the workday left, the employee is expected return to work. If on the day of the injury the employee chooses not to see a doctor but decides to seek medical attention at a later date, the time required to attend the doctor visit (if during working hours) will be eligible for Injury/Illness In The Line Of Duty. What is Injury/Illness In The Line Of Duty (IILOD) Injury/Illness In The Line Of Duty is a benefit provided by the School Board when an employee is absent due to personal injury/illness which occurred while working. Who is eligible for IILOD? All full-time and part-time employees are eligible for benefits. Substitutes & Volunteers are not eligible for IILOD.

4 Is it necessary that an injury or illness be reported to our Workers Compensation carrier before IILOD can be used? Yes. Can an employee use IILOD and seek treatment with a personal physician? No, the employee must treat with an approved Workers Compensation physician. How many days are allowed each year for IILOD? Leave for Injury/Illness In The Line Of Duty is granted for up to 10 days (or the hour equivalent of two regular workweeks) per year (7/1 6/30). Does an employee get 10 days IILOD per year for each injury? No, an accumulated total of 10 days per year is available for each employee. Will the use of IILOD affect an employee s sick, personal or vacation time. No. Under what circumstances can IILOD be used? Illness In The Line Of Duty must be used: When a Workers Compensation physician takes an employee off work. Documentation from the doctor must accompany the IILOD form. When an employee has a doctor or physical therapy appointment (through Workers Compensation) during working hours, the time missed to attend the appointment is eligible for IILOD. Documentation from the doctor or facility must accompany the IILOD form. How is IILOD entered on SAP? The employee must have written documentation from a Workers Compensation physician/facility for the time missed. Time may be entered in hours or partial hours up to the maximum of 10 working days (or the hour equivalent of two workweeks). Enter IILOD on SAP using code 0I40. The entire IILOD form (except gold copy), with documentation attached, should be sent to Jennifer Hooper in Risk Management. Retain gold copy for school/department record.

5 Will SAP stop accepting code 0I40 when all IILOD days have been used? No. Can code 0I89 be used to pay for time away from work to attend doctor or physical therapy appointments? No, if all IILOD days have been exhausted, time used for a doctor visit during working hours would be taken from the employee s time (sick, vacation, etc.). How is time entered if the employee is out for more than 10 days? If the Workers Compensation physician takes an injured worker off work for more than 10 days. Time is entered beginning the 11th day using code 0I89. This code lets the system know that our Workers Compensation carrier will be paying the Workers Compensation portion of the injured worker s salary. What portion of the injured worker s salary will be paid by the Workers Compensation carrier? By law, Workers Compensation will pay 66 2/3% of the injured worker s salary. Won t the fact that Workers Compensation pays only 66 2/3% of an injured worker s salary cause that person to receive a short check? Yes, however, the School Board, as a benefit to the employee, customarily deducts 1/3 of a day, from the employee s sick time (if available), per day of Workers Compensation (0I89). This check will be sent to the employee from the School Board. The portion of the injured worker s salary paid by the Workers Compensation carrier will come directly from the carrier. These two amounts will ensure that the injured worker will receive his/her full salary. (Remember, split time is entered after all IILOD days have been used). Who should enter the split time on SAP? This time should be entered by the school/department payroll secretary.

6 How should split time be entered on SAP? When entering time for an employee out on Workers Compensation. (0I89), two thirds of the day is keyed 0I89 (workers Compensation) and one third of the day is keyed 0I62 (sick leave). For a 10 hour employee 6.67 hours should be keyed 0I89 (workers Compensation) and 3.33 hours should be keyed 0I62 (sick leave) hours hrs. 0I89 (workers Compensation) and 2.67 hrs. 0I62 (sick leave) 7.75 hours hrs. 0I89 (workers Compensation) and 2.58 hrs. 0I62 (sick leave) 7.50 hours hrs. 0I89 (workers Compensation) and 2.5 hrs. 0I62 (sick leave) 7.25 hours hrs. 0I89 (workers Compensation) and 2.42 hrs. 0I62 (sick leave) 6.75 hours hrs. 0I89 (workers Compensation) and 2.25 hrs. 0I62 (sick leave) 6.50 hours hrs. 0I89 (workers Compensation) and 2.17 hrs. 0I62 (sick leave) 6.00 hours hrs. 0I89 (workers Compensation) and 2.0 hrs. 0I62 (sick leave) 5.75 hours hrs. 0I89 (workers Compensation) and 1.92 hrs. 0I62 (sick leave) 5.50 hours hrs. 0I89 (workers Compensation) and 1.83 hrs. 0I62 (sick leave) 5.00 hours hrs. 0I89 (workers Compensation) and 1.67 hrs. 0I62 (sick leave) 4.00 hours 2.67 hrs. 0I89 (workers Compensation) and 1.33 hrs. 0I62 (sick leave) What if the injured worker has no sick time available? If no sick time is available the injured worker would receive only the portion of salary (66 2/3%) paid by Workers Compensation. However, if the employee earns vacation time this can be used for split time but only with permission from the employee prior to entering time on SAP. How should the day be entered on SAP if there is no time available to use for split time? Enter Workers Compensation time as usual - 0I89. Enter remaining time as 0I52 (no pay). If all personal time has been exhausted, is an injured worker allowed to use time from the Sick Leave Bank for the onethird day Workers Compensation does not pay? No, the one-third day should be entered as 0I52 (no pay).

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